Perioperative management strategies for penile prosthesis implantation - data from the prospective national registry “INSIST-ED”

Objective: Local infections still represent the most fearsome complication of penile prosthesis implantation (PPI). Aim of this study was to analyze differences in perioperative management strategies applied for PPI in a national-based registry. Materials and Methods: Data were analysed from a national multi-institutional database of PPI including patients treated from 2014 to 2017 in Italy (INSIST-ED). All data have been prospectively recorded by 45 surgeons on a dedicated website (www.registro.andrologiaitaliana.it) and critically revised by a single datamanager. The application of perioperative management strategies to avoid local infection as suggested by the ISSM guidelines (namely, double-agent preoperative antibiotic therapy, use of double gloves and application of the “no-touch” technique) were analysed. Results: Complete data were available for 402 patients. Overall, one-shot preoperative antibiotic therapy (1h before surgery), with a double agent covering Gram+ and Gram- bacteria, was used in 69% (279) of cases. Among them, the combination of Aminoglycosides + Glycopeptides emerged as the most frequently used therapy [167 (59.8%)]. A total of 123 (31%) patients received a single drug as preoperative antibiotic prophylaxis; of them, 30.1% (37) had already received an antibiotic therapy course within 1 and 7 days before surgery. During the procedure, the application of the “no-touch” technique and the use of double gloves were reported in 13% (52) and 29% (115) of the cases, respectively. A surgical drain was placed in 44% (176) of the cases. Overall, the ISSM recommendations to reduce the risk of local infections, were thoroughly followed in only 4% (16) of the cases. Conclusions: Perioperative management strategies to prevent surgical infection in PPI emerged to be highly heterogeneous. Physicians should be aware of the importance to properly follow the available recommendations in order to reduce the risk of infections in penile prosthesis surgery